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YTC-30280-60681

2 vaccinations 7 coded responses 8 check-ins 7 free-text entries 3 call cases
Sex
Male
Age at first dose
61-65
ZIP prefix
301 / GA
Registered
2021-03-09
Relationship
Self
Race
White
Ethnicity
Not Hispanic or Latino

Timeline

  1. 2021-01-28
    Dose 1 — Moderna
  2. 2021-02-26
    Dose 2 — Moderna
  3. 2021-03-09
    Registered in v-safe
  4. 2021-03-09
    Survey response — day 7, dose 2
    MedDRA: Herpes zoster, Sensitive skin — Feeling: Poor · Site: Pain, Redness, Swelling · Headache, Muscle or body aches, Fatigue or tiredness, Rash, not including the immediate area around the injection site · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Outpatient clinic or urgent care clinic visit
    Free text: Systemic reaction (other): Shingles · Healthcare visit (other): Sensitive skin diagnosis shingles
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  5. 2021-03-09
    Report sent to call center — day 7, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  6. 2021-03-12
    Survey response — day 14, dose 2
    MedDRA: Breast swelling, Flank pain, Herpes zoster — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Pain in left side and swollen breast. Shingles have spread
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  7. 2021-03-19
    Survey response — day 21, dose 2
    MedDRA: Abdominal discomfort, Abdominal pain, Axillary pain, Chest pain, Hypoaesthesia, Oedema peripheral — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Left chest and under arm swelling and painful. Left side of stomach heavy or numb feeling. Painful to drive my car or hit bumps in road. Have to hold my left side to do anything
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  8. 2021-03-27
    Survey response — day 28, dose 2
    MedDRA: Abdominal pain upper, Chest pain, Hospitalisation — Feeling: Poor · Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization
    Free text: Hospitalized for blood clots in leg and chest. Hospitalized given intravenously with blood thinners. Home with blood thinners, still having pain in chest and stomach area
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  9. 2021-03-27
    Report sent to call center — day 28, dose 2
    Get care from a doctor or other healthcare professional
    1 call case(s)
  10. 2021-04-04
    Survey response — day 35, dose 2
    MedDRA: Dyspnoea, Emergency care, Hospitalisation, Pyrexia, Thrombosis — Feeling: Poor · Be unable to do your normal daily activities, Get care from a doctor or other healthcare professional · Emergency room or emergency department visit, Hospitalization
    Free text: High fever 103, struggling to breathe, took to ER where they found 3 blood clots admitted to hospital (b)(6) Medical Center, put on blood thinners and oxygen
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  11. 2021-04-04
    Report sent to call center — day 35, dose 2
    Be unable to do your normal daily activities · Get care from a doctor or other healthcare professional
    1 call case(s)
  12. 2021-04-09
    Survey response — day 42, dose 2
    MedDRA: Herpes zoster, Pain — Feeling: Poor · Be unable to do your normal daily activities
    Free text: Severe pain from shingles although they have healed the pain is still there.
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  13. 2021-05-30
    Survey response — 3 months, dose 2
    MedDRA: Lymphadenopathy — Feeling: Fair · Be unable to do your normal daily activities
    Free text: Swollen lymph nodes are back
    MedDRA releases: 2021-09,2023-04,2024-11 · check-in free text available
  14. 2021-06-15
  15. 2021-06-21
  16. 2021-06-24
  17. 2021-09-01
    Health check-in — 6 months, dose 2
    Feeling: Good
    Adult check-in

Vaccinations

DoseDateManufacturerCo-administered
12021-01-28Moderna
22021-02-26Moderna

Call center

ReportedOutcomeVAERS-related outcome
2021-03-09 Unsuccessful
2021-03-27 Unsuccessful
2021-04-04 Unsuccessful

Free text

Release 5 — day 7, dose 2

2021-03-09

Systemic reaction (other): Shingles
Healthcare visit (other): Sensitive skin diagnosis shingles

Release 5 — day 14, dose 2

2021-03-12

Symptoms: Pain in left side and swollen breast. Shingles have spread

Release 5 — day 21, dose 2

2021-03-19

Symptoms: Left chest and under arm swelling and painful. Left side of stomach heavy or numb feeling. Painful to drive my car or hit bumps in road. Have to hold my left side to do anything

Release 6 — day 28, dose 2

2021-03-27

Symptoms: Hospitalized for blood clots in leg and chest. Hospitalized given intravenously with blood thinners. Home with blood thinners, still having pain in chest and stomach area

Release 6 — day 35, dose 2

2021-04-04

Symptoms: High fever 103, struggling to breathe, took to ER where they found 3 blood clots admitted to hospital (b)(6) Medical Center, put on blood thinners and oxygen
redacted (b)(6)

Release 7 — day 42, dose 2

2021-04-09

Symptoms: Severe pain from shingles although they have healed the pain is still there.

Release 8 — 3 months, dose 2

2021-05-30

Symptoms: Swollen lymph nodes are back

Each entry is dated by the survey it was written in (the CDC re-sent the releases with survey dates in 2025); click a date to see that survey response. The CDC cut some text off at about 250 characters: symptoms in every release, and the other two fields in releases 9-12. Those entries are marked "cut off by CDC".

MedDRA terms by release

FieldPreferred term2021-092023-042024-11
HCVOHerpes zoster ✓ ✓ ✓
HCVOSensitive skin ✓ ✓ ✓
SDAbdominal discomfort ✓ ✓ ✓
SDAbdominal pain ✓ ✓ ✓
SDAbdominal pain upper ✓ ✓ ✓
SDAxillary pain ✓ ✓ ✓
SDBreast swelling ✓ ✓ ✓
SDChest pain ✓ ✓ ✓
SDDyspnoea ✓ ✓ ✓
SDEmergency care ✓ ✓ ✓
SDFlank pain ✓ ✓ ✓
SDHerpes zoster ✓ ✓ ✓
SDHospitalisation ✓ ✓ ✓
SDHypoaesthesia ✓ ✓ ✓
SDLymphadenopathy ✓ ✓ ✓
SDOedema peripheral ✓ ✓ ✓
SDPain ✓ ✓ ✓
SDPyrexia ✓ ✓ ✓
SDThrombosis ✓ ✓ ✓
SROHerpes zoster ✓ ✓ ✓

✓ active code · ○ coded but marked inactive · blank = not in that release